Provider Demographics
NPI:1174959431
Name:WELLNESS CENTER
Entity type:Organization
Organization Name:WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:A
Authorized Official - Last Name:JAHRIES
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:435-604-0259
Mailing Address - Street 1:8178 GORGOZA PINES RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-4607
Mailing Address - Country:US
Mailing Address - Phone:435-604-0259
Mailing Address - Fax:435-604-0260
Practice Address - Street 1:8178 GORGOZA PINES RD
Practice Address - Street 2:SUITE H
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-4607
Practice Address - Country:US
Practice Address - Phone:435-604-0259
Practice Address - Fax:435-604-0260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-18
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT199354-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty